What causes male pattern baldness?

In medical terms, male pattern baldness is known as androgenic alopecia or androgenetic alopecia. It can start at any age, and you may have a higher risk of getting it if you have a family history of hair loss.

Hair loss occurs when your hair follicles shrink to the point where new hair cannot grow, in a process called miniaturisation. How quickly miniaturisation occurs depends on each person, but it usually takes between 5 and 15 years.

During miniaturisation, the hair follicle will shrink so that your hair becomes shorter. You might notice your hair falling out easier whilst brushing or washing, or becoming thinner. Over time, the hair follicle will shrink completely.

The symptoms of male pattern baldness include:

• a receding hairline, which causes your hairline to gradually move backwards
• a thinning crown
• diffuse thinning (hair thinning evenly across your scalp)
• hair that becomes thinner, shorter, and finer over time

The main cause of male pattern baldness is hormones, also called androgens. If you have too much of an androgen called dihydrotestosterone (DHT), you might be at risk of hair loss.

DHT is made from testosterone and is a powerful type of androgen. When it binds to the same receptors that testosterone does, it creates a greater effect. This means when DHT binds to an androgen receptor, it starts the process of hair miniaturisation. You have more androgen receptors in the front of your scalp than at the back or sides. This explains why you might lose hair or find bald patches near your hairline more than anywhere else on your scalp.

By suppressing the amount of DHT in your scalp, you can slow down and prevent the process of hair loss. Interestingly, the presence of DHT in other parts of your body, like your beard line or chest, can cause an increase in hair growth.

Several risk factors can increase your chances of getting male pattern baldness, including:

• Family history/genetics which can be passed down by male or female relatives.
• Age – In one study, 53% of men who experienced moderate to extensive hair loss were aged between 40 to 49.
• Certain medications may trigger the onset of male pattern baldness, such as blood thinners, beta blockers, and antidepressants.
• Nutritional deficiency, including vitamins A, B, C, D, E, and iron.

You can still get male pattern baldness without having any of these risk factors, although these can make it more likely to develop.

If you think you have male pattern baldness, you can make an appointment with your doctor. During the appointment, they will:

• Ask about your symptoms and examine your hair, looking at the appearance and pattern of hair loss. It can also help if you take pictures of your hair, so you and your doctor can see how it changes over time.
• Take your medical history, including your family history, to determine if hair loss is prevalent in your genetics.

You may also be referred to a dermatologist who can look at your scalp through a microscope. This allows them to assess the stage of miniaturisation.

If your doctor isn’t sure or wants to rule out other conditions, they may take a swab of your scalp to test for fungal infections. You may need to take a blood test to check if your hair loss is due to a nutritional disorder, such as a vitamin deficiency.

If hair loss is caused by lifestyle factors, stress, medications, or pregnancy, it can usually be prevented by removing or treating the cause. Your doctor will determine whether your hair loss can be prevented or treated.

Hair loss cannot be prevented if it’s caused by a genetic condition, such as male pattern baldness. In these cases, you can use treatment to slow down the process.

There are a number of male pattern baldness treatments that can improve the look of your hair and slow down the process of miniaturisation. Some of the best hair loss treatments for men include finasteride, Propecia, and minoxidil.

Finasteride is a prescription-only medication that is used to slow down the process of male hair loss by stopping the production of DHT. Finasteride 1mg tablets are taken daily and you’ll usually see an improvement after 3 to 6 months of use. Finasteride only works while you are taking it. After stopping treatment, the results will start to reverse with a return to baseline being seen by 9 to 12 months. Finasteride is also available under the brand name Propecia.

Minoxidil is an over-the-counter hair loss treatment. You can buy minoxidil as a scalp foam under the brand name Regaine. You should use it for up to 4 months to allow time for your scalp to be treated. If you do not see any improvement after 4 months, speak to your doctor.

Other treatments available for male pattern baldness include:

• hair transplant
• tattooing
• scalp reduction surgery – this works by taking sections of your scalp that are covered with hair, stretching them and then stitching it together
• artificial hair transplant – a surgery to implant artificial hairs into your scalp

Some of these treatments may only be available privately.

There are also things you can do at home to help, such as:

• regular scalp massages to increase blood flow
• managing stress
• quitting smoking
• using a thickening shampoo
• speaking to a counsellor if you need emotional support due to hair loss
• wearing a wig or toupee to cover any partial baldness